Pregnancy During Melanoma and Subsequent Pregnancies
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I was diagnosed with stage 1b melanoma when I was 30 weeks pregnant. I had a surgery and SLN biopsy at 32 weeks (biopsy was negative). It has been two years since my diagnosis and my husband and I would like to try for baby #2, but we are getting mixed opinions from doctors. The biggest concern from my primary derm. oncologist is the immune system during pregnancy. If there are occult melanoma cells that were not detected during the SLN biopsy, perhaps the pregnancy could allow the melanoma to come back. I have done lots of research and see other doctors, but am scared to take on that extra risk. We really want another child. Has anyone had a similar experience? Sorry, I don’t have any answers, just another question. The notion of “occult melanoma cells that were not detected during the SLN biopsy” – is that something that applies to anyone who has had this procedure? What does that mean, that they missed something? I believe it means that a negative SLN biopsy is not a 100% guarantee that there are not melanoma cells somewhere in the body. There could be cells that are not detected. Though the chance (with a negative SLN biopsy, clear blood tests, and clear chest x-ray, in my case) of there being occult cells is very rare, there is still a very small chance. This is my understanding of it. If someone else has something to add, please do so. It’s very confusing to me too. When you say “clear blood tests” I didn’t think there were any blood tests for melanoma? The thing that confuses me is it seems like there are a few options after WLE/SLN: Either that cleared your body of all the cancer cells or some rogue cells went astray either via the bloodstream or the lymphatic system (to different node than sentinel node, or hadn’t reached the node yet at the time of SLN, etc..), and if that happens – you may never know it if your body seeks and destroys those cells or if they are dormant (but of course could become a problem many years later). But, then I’ve also heard that a lesion that is shallow depth or thickness is highly unlikely (and nearly biologically impossible) the ability to spread. So, I don’t know what to think, it seems very complicated. Have you tried to get an opinion yet from a recognized melanoma expert? I mean, ordinary dermatologists know about melanoma, but speaking to someone who focuses more narrowly on this type of thing might be of use. There are not any studies indicating a connection between pregnancy (hormones) and melanoma. But young women get pregnant and young women get melanoma. I was told to wait two years as that is the probable time for recurrence. And you dont’ want to deal with recurrence and pregnancy at the same time! So a decent waiting time is ideal. And unfortunately the clear SLNB is not a 100% guarantee that cells could still be in the blood stream. But I agree, see an expert for an opinion if it might reassure you. (but don’t freak out about this Cohanja, either because the depth is the prognostic indicator that seems to always ring true.) I saw two doctors regarding this topic, both melanoma specialists from leading cancer centers in the U.S. They had different opinions. One said not to wait at all and that there was no connection (the second opinion) and the other, my primary doctor, said that there is not enough research to know for sure whether or not the state of the immune system during pregnancy could lead something. So confusing . . . Medicine is an art not a science. Based on research (all we have) there’s no conclusive evidence. Immune system isn’t the question usually, but presence of growth hormones and other hormonal influences of pregnancy. Again, large study of 800 women plus showed very minimal effect of hormones on melanoma. But good to give it two years for the reasons I stated previously. Glad to see you laughing Cohanja!
link to a 2009 study on pregnancy and melanoma http://www.sciencedaily.com/releases/2009/05/090504210204.htm
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